Hormone Replacement Therapy and The Liver

All drugs, including natural hormones, must eventually pass through the liver, where they are filtered out of the blood stream and broken down (metabolised) into forms that can be eliminated from the body via the bile or urine.

Hormone Replacement Therapy (HRT) that is taken in a tablet (oral) form, will be absorbed from the intestines and pass immediately through the liver via the liver’s portal circulation of blood. Thus the liver may break down a large portion of the hormone dose before it can get into the general circulation to be carried to the body cells. This is why higher doses of hormones are required if they are administered in tablet form. In many people this does not cause any problems, whereas in others the liver may either render the hormones ineffective or become overworked by the task of breaking down the hormones. In the latter case, side effects such as weight gain, fluid retention, nausea, headaches, high blood pressure or even blood clots may result. In such cases it is best to stop the hormone therapy or change to another form of hormone therapy which is not absorbed from the intestines into the liver.

It is easy to administer natural hormones (bio-identical hormones) in forms that are absorbed directly into the blood circulation before they get to the liver. This enables smaller doses to be used because the hormones have a chance to perform their function on the body cells before the liver breaks them down.

Suitable forms of hormones to achieve this effect can be delivered though the skin. For examples, patches or creams. Hormones in patches and/or creams are absorbed very well across the skin into the small blood vessels found in the subcutaneous layer of the skin. Patches are available containing natural estrogen or natural estrogen plus progestogen. Hormone creams give more flexibility because they can be tailor made to suit the individual, and can be compounded to include any variety of natural hormones such as the three different types of natural estrogen (estradiol, estrone and estriol), natural progesterone, testosterone and DHEA. It is also easier to adjust doses of hormones up or down in such creams. Generally half a teaspoon of the cream is used and massaged into the skin of the inner upper thigh twice daily. The skin must be dry and the cream must be massaged deeply into the skin. In those who are overly sensitive to hormones or have medical problems, we can use very small and therefore very safe doses of hormones in cream form. This is a breakthrough for women with medical problems who have been told that they can never enjoy the benefits of natural hormone replacement therapy. See Dr Sandra Cabot’s Book titled “HRT – The real truth”

I have been treating women with hormonal problems since the mid 1970s, and have seen many trends and fashions in hormonal replacement therapy come and go. The most important thing that I have learnt, is that every woman is an individual and needs fine-tuning to balance her unique hormonal and metabolic characteristics. You do not learn this from textbooks but from seeing thousands of women over many years who have often tried many other avenues of help. Some women require much higher doses and wider varieties of hormones than do others, although I always like to start with the smallest necessary dose. Initial prescriptions and follow up adjustments to dosage must be guided by measuring the level of hormones in the blood. These blood tests are very accurate. I prefer using blood tests to salivary hormone tests, although those experienced with the latter may find them of use.

When choosing Hormone Replacement Therapy (HRT), your Body Type needs to be taken into consideration

Android women and men tend to put on weight in the upper part of their body, especially around the midriff, and may develop a pot belly and a roll of fat around the liver. I call this the “liver roll.” Fatty liver is more common in Android shapes and makes it difficult for them to lose weight. Because their liver is often dysfunctional they do not tolerate large doses of hormones. Furthermore they do not need large doses, because they still produce significant amounts of hormones from their fat and adrenal glands after the ovaries shut down at menopause. After menopause they tend to produce plenty of male hormones such as DHEA and testosterone from their adrenal glands, and their bone density is usually good. Although I am generalising, I would tend to use small doses of natural estrogens and progesterone in the form of creams for Android women. This is because this form of HRT does not stress the liver and will not cause weight gain and side effects. Furthermore it is easy to fine-tune the doses of hormones up or down in these hormonal creams.

Gynaeoid women have wide curvaceous hips, and tend to put on weight in the estrogen dependent areas of the body such as the hips, lower buttocks and thighs and may get cellulite in these areas. They tend to be estrogen dominant and need more progesterone than any other hormones. I would tend to use only small doses of natural estrogen, and larger doses of natural progesterone in the form of lozenges or creams.

Thyroid body types are fine boned with long and lean limbs and may have an earlier than average menopause. They do not produce significant levels of steroid sex hormones during the postmenopausal years and may have severe symptoms of menopause. Their bone density tends to be low and osteoporosis is a concern in these very fine boned women. They often need higher doses of a wider range of hormones such as testosterone, DHEA, estrogen and progesterone. Creams may not be strong enough and they may prefer lozenges or even implants or injections.

Lymphatic body types are the opposite of the thyroid types, in that they put on weight very easily. This weight is distributed all over their body so that they have thick puffy limbs. They have a dysfunctional lymphatic system, which causes fluid retention and bloating. They really need to follow a dairy free diet, and do regular exercise to control their weight and fluid excess. I would tend to use hormonal creams in lymphatic body types because they do not aggravate fluid retention. Lymphatic types can use natural diuretics such as garlic, ginger, parsley and the herbs dandelion and uva ursi, to promote the elimination of excessive fluid.